Contract Nursing Home Exclusion Review

Part of the initial review for contracting and part of the annual review.

Name of Nursing Home

WOODVIEW A WATERS COMMUNITY

Address

3420 EAST STATE BLVDFORT WAYNE IN, 46805

Telephone

Six Digit Provider Number

155255

A. Deficiencies

Rating (G-L)

Program Requirements

Corrected Date

Current Survey Date

J

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident??s advance directives.

04/08/2018

03/09/2018

Deficiency Count:

1

Section Rating:

PASS

*Facility fails if there are three level "G" or worse deficiencies in the current survey.

B. Health Requirement Deficiencies

Current Number at Facility

State Average

Total Health Requirement Deficiencies:

10

5.8

Section Rating:

PASS

Health Requirement Deficiencies: (The total number of health requirements deficiencies cannot be more than twice the State average in the current survey.)

C. RN Hours

RN Hours

Current Average at Facility

State Average

RN Hours per Resident Day:

0.54

0.65

Section Rating:

FAIL

* Program requirement: Fail if less than state average

D. Total Nursing Staff

Total Nursing Staff

Current Average at Facility

State Average

Total Nursing Staff Hours per resident Day:

4.7

3.66

Section Rating:

PASS

* Program requirement: Fail if less than state average

E. Quality Measures

NOTE:

Although the Centers for Medicare and Medicaid Services (CMS) has released 24 Quality Measures, current VHA guidelines indicate that the following 18 Quality Measures be used to determine Pass/Fail for Section G of the review.

Quality Measures

Facility Percent

State Average

Flagged

Percentage of high risk long-stay residents with pressure ulcers

0%

4.5%

Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine

0%

87.6%

Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine

0%

89%

Percentage of long-stay residents experiencing one or more falls with major injury

0%

3.5%

Percentage of long-stay residents who have depressive symptoms

0%

6.9%

Percentage of long-stay residents who lose too much weight

0%

6.8%

Percentage of long-stay residents who received an antipsychotic medication

0%

13.9%

Percentage of long-stay residents who self-report moderate to severe pain

0%

4.2%

Percentage of long-stay residents who were physically restrained

0%

0.3%

Percentage of long-stay residents whose need for help with daily activities has increased

0%

14.3%

Percentage of long-stay residents with a catheter inserted and left in their bladder

0%

1.2%

Percentage of long-stay residents with a urinary tract infection

0%

2.7%

* A facility fails when six or more of the CMS Quality Measures listed below in Nursing Home Compare fall above the state average.
N.A.= contact home, data not submitted N.S. = contact home, numbers too small

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